ED Coding and Reimbursement Alert

Elimination of grace period boxes you in to Oct.1

Set your calendars, practices: CMS isn't cutting anyone slack this fall when the new ICD-9 and HCPCS codes take effect. Starting Oct. 1, 2004, you either assign the new codes or expect denials, the agency says.

According to two Feb. 6 CMS transmittals (Nos. 89 and 95), the grace period allowed providers "to ascertain the new codes and learn about the discontinued codes," CMS says. But "HIPAA Transaction Standards eliminated the 90-day grace period for updating codes and requires providers to use the ICD-9 code in effect when service was provided," explains Prinny Rose Abraham, RHI, CPHQ, a health information management consultant with HIQM Consulting.

The result: You will have to begin using new and revised ICD-9 codes on Oct. 1, 2004. You will not have 90 days to continue using the old codes. For CPT codes and HCPCS Level II codes, you will need to implement any additions, revisions and deletions the day the new codes take effect: Jan. 1, 2005.

Planning: You need to be aware of the upcoming new diagnosis codes and instruct coders or staff on their availability prior to Oct. 1, says Ida Belvins, a coding specialist at St. John's Hospital in Springfield, Mo.

Consequence: Claims using outdated codes "will automatically be returned to the provider for corrections, which could slow down cash flow and result in extra time spent correcting documentation as well as claims, says M. Aaron Little, CPA, supervising consultant with BKD LLP in Springfield, Mo.